Bryant England, M.D., a rheumatology fellow in the UNMC Department of Internal Medicine, has teamed with a group including Ted Mikuls, M.D., professor of rheumatology and immunology, to publish a study in Arthritis & Rheumatology.
The study explores how cytokines and chemokines — cellular messaging systems allowing one cell to “talk” to another — may impact cancer mortality in patients with rheumatoid arthritis (RA).
Cytokines and chemokines become dysregulated in patients with RA, Dr. England said.
“They generate and sustain an inflammatory environment within the joints,” he said. “That inflammation doesn’t just stay in the joint — that inflammation circulates throughout the entire body, and part of the reason for that is because the cytokines aren’t just acting in the joint, but they circulate in the body.
“What this (study) showed is that by measuring circulating cytokines that become dysregulated in RA, we could predict those (individuals) who went on to die of cancer.”
The study draws from a database of VA patients with RA that Dr. Mikuls created, allowing Dr. England and his team to look at years of data, including cause-specific mortality in the patients.
“The basic question we asked was ‘Can serum cytokines predict how people die?'” Dr. England said.
Even after adjusting for other risk factors, such as smoking, the “cytokines are still telling us something important about cancer mortality risk,” he said.
Dr. England, a native of Elliott, Iowa, both went to medical school and completed his internal medicine residency at UNMC — he is currently a first-year rheumatology fellow. He credits Dr. Mikuls with cultivating his interest in research; the two have published together in the past.
“I saw his passion for research and now I also want to pursue a career as a physician scientist,” Dr. England said.
In the wake of their latest publication, Dr. England hopes to build on his findings.
“This is an association, but this doesn’t prove causation,” he said. “One of the potential explanations for this finding is that the grade of cancer, especially having metastatic cancer, is closely related to cancer mortality. So is it that these RA patients have more advanced cancer at the time that it’s found? That’s a follow up study we have planned.”
Congratulations, Bryant. Excellent work.